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To investigate the efficacy and safety of the technique of instillation of normal saline prior to suction of airways in intubated patients.

Databases searched included: MEDLINE, CINAHL, EMBASE, Cochrane Controlled Trials Register and Full text clinicians’ health journals @ Ovid from the earliest time to March 2009. Citation tracking of relevant primary and review articles.

All randomised controlled trials, crossover trials, quasi- and full systematic reviews were screened. From 65 articles screened, 17 articles (two quasi-systematic reviews and 15 empirical studies) met the eligibility criteria and were included for data extraction. The outcomes in the reviewed studies included oxygenation, lung mechanics, sputum yield, dyspnoea, tube patency and ventilator-associated pneumonia. Effect sizes and 95% confidence intervals were calculated.

Studies were …